This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Tuesday, January 19, 2016

The Australian’s Contributing Economics Editor Highlights The Huge Number Of Bungles In Government E-Health.

It’s a type of childlike optimism — the idea that governments can achieve lots of good things through the creation of large-scale, all-embracing information technology platforms. We just need more data and more investment in IT systems, so the central planners will argue, and the benefits will flow forever.

Indeed, our Prime Minister is very much taken by the potentially transformative power of government investments in IT. “Right across the board, you will see there are measures to ensure that government is digitally transformed, so that it is nimble, so that you can deal with government as easily as you can with eBay or with one of the big financial institutions.”

Or take this statement of faith by an ex-Treasury official: “The adoption across all levels of government of uniform IT systems in the health and education sectors, allowing a client’s entire service history to be tracked. Bingo!

“Then each and every service provided will be recorded, for all time, and can be benchmarked for performance. No more students leaving school who can’t read without a clear audit trail. No more health specialists charging differing fees for the same procedure without sanction. In other words, let digital disruption loose in core public service provision to drive up quality and drive down costs and the number of poor outcomes for consumers.”

Don’t you just love it? Uniform IT systems in health and education and all of our problems will be solved. Here are two things you should consider:

In point of fact, there is currently in place a recording arrangement that tracks students from childcare and preschool through school, including information about their NAPLAN and final school results. Have these unit record data led to the outcomes our confident ex-bureaucrat predicts? Have school costs been driven down and the number of poor outcomes fallen? I think my readers know the answers.

The second point to make is that the number of government IT disasters is legion. The nature and size of the failures are generally hidden from the public as long as possible until a pesky auditor-­general does some poking around. We then learn about large-scale IT projects that have cost hundreds of millions of dollars — sometimes more — that have had to be abandoned or modified at huge cost.

But it would seem that unless there is a direct interface with the public — a public transport ticketing system, for example — there are very few political consequences for the governments committing taxpayer funds to ill-conceived IT projects that never succeed.

Let me just go through some of the examples I have been able to dig up. It is really very difficult to know where to start; there are so many examples and the sums of money are just so massive.

It’s hard to go past the disastrous eHealth program initiated by the Gillard Labor government. It has now burned through a cool billion dollars and there is effectively nothing to show for it. Designed to “electronically connect up the points of care so that health information can be shared securely”, both health practitioners and patients have rightly taken a dim view of the project from the very start.

A trivial proportion of the population has “Personally Controlled Electronic Health Records”, making the whole exercise pointless. But rather than ditch what is an incredibly wasteful commitment of taxpayer money, the current government has decided to press on and switch from an opt-in arrangement to one in which patients are forced to have a PCEHR unless they object. I guess that makes sense for a government with supposedly (classical) liberal values.

But, of course, the disastrous eHealth project is just one of many. Recall the fiasco of the computerised payroll system for Queensland Health. It is quite hilarious that the three parties involved in the project — Queensland Health, the government-owned CorpTech and IBM — initially estimated that the project would cost $6 million. It’s difficult to get to the bottom of the final cost of the project and the delay, but $1 billion and four to five years late would be reasonable guesses.

Judith Sloan is an economist and company director. She holds degrees from the University of Melbourne and the London School of Economics. She has held a number of government appointments, including Commissioner of the Productivity Commission; Commissioner of the Australian Fair Pay Commission; and Deputy Chairman of the Australian Broadcasting Corporation.”

Ms Sloan is hardly a left wing apologist and she is making it pretty clear she is really struggling to understand two things:

1. Just why the present Government is pressing on with the PCEHR.

2. Just why we seem to have so many failures in this area.

I do hope some in the Government bother to read her commentary and maybe, just maybe, ask a few pertinent questions.

Re: "I do hope some in the Government bother to read her commentary and maybe, just maybe, ask a few pertinent questions."

Prime Minister Turnbull may not have seen the article. He most definitely should. If he does see it, it is highly likely he will develop a very deep and genuine interest in the profligate wastage of over $1 billion that we have witnessed for over a decade under previous Health Ministers; all of whom have been advised by one long standing Department Secretary who has now finally been moved on.

"...the complications arising from the complexity of the underlying information being digitised are too often overlooked. One of the troubles with the eHealth initiative is that quite of lot of what is contained in patient management records is not amenable to simple classification."

The solution may involve IT, but the problem is always about patient information, a subject that is full of contradictions, paradoxes, uncertainties and incompleteness.

IMHO, neither IT people nor health professionals fully understand what this means. Until they do, we will have failure after failure and not just poor outcomes, but dangerous consequences to both patient safety and privacy.

Re: 'Running XP is just unacceptable' : I don't think too many people in the Victorian public system would have been surprised to hear that there are still XP machines around, though at least in some quarters there did seem to be an effort to weed them out last year (!). Perhaps since HealthSmart the IT funding tap has been turned off, whether for babies or bathwater...